{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T14:53:48Z","timestamp":1790952828403,"version":"4.1.0"},"reference-count":68,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Although\n                      <jats:italic>Pneumocystis jirovecii<\/jats:italic>\n                      pneumonia (PJP) outbreaks continue to occur in solid organ transplantation (SOT) recipients, no systematic review has synthesized the available evidence to provide an aggregated understanding of their epidemiology and transmission.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched MEDLINE, Embase, Cochrane, and manual sources through May 1, 2024 for studies of PJP outbreaks in adult SOT recipients. Data on patient characteristics, immunosuppression, diagnostics, outcomes, outbreak investigations, and control measures were extracted. The primary outcome was all\u2010cause mortality, and the secondary outcome was characterization of outbreak investigation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010nine outbreaks involving 360 SOT recipients (median age, 51.8 years [range, 22\u201370.5 years]; 32.6% female) were identified. Late\u2010onset PJP (&gt; 1 year posttransplant) occurred in 92.6% of outbreaks, which lasted a median of 365 days (range, 90\u20131260 days); kidney transplant recipients accounted for 77.8% of cases. Across 22 studies, the crude aggregate mortality was 19.0% (51 of 268 patients), while 27 of 64 patients (42.2%) required dialysis in six studies. Most patients were not on prophylaxis at diagnosis; breakthrough infections were rare (&lt; 5%). Molecular typing was performed in most studies (21\/28, 75%) among which single or predominant genotypes were identified in 19\/20 (95%), supporting clonal transmission. Control measures included extended prophylaxis and surveillance, although their individual effectiveness could not be determined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Transplant centers remain susceptible to prolonged PJP outbreaks associated with substantial mortality. Nosocomial airborne transmission is likely. Most outbreaks occurred after prophylaxis discontinuation, but optimal control measures and prophylaxis duration remain uncertain. Standardized investigations incorporating molecular epidemiology will guide outbreak control and prevention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tid.70333","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T14:01:23Z","timestamp":1790949683000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<i>Pneumocystis jirovecii<\/i>\n                    Pneumonia Outbreaks in Solid Organ Transplant Recipients: A Systematic Review of Epidemiology, Transmission Dynamics, and Outbreak Investigations"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2013-1249","authenticated-orcid":false,"given":"Francesca","family":"Gioia","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Hospital Central de La Cruz Roja San Jos\u00e9 y Santa Adela  Madrid Spain"},{"name":"CIBER de Enfermedades Infecciosas (CIBERINFEC)  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Almansour","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Internal Medicine King Abdulaziz Medical City National Guards Health Affairs  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9943-2692","authenticated-orcid":false,"given":"Ani","family":"Orchanian\u2010Cheff","sequence":"additional","affiliation":[{"name":"Library and Information Services University Health Network University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay A.","family":"Fishman","sequence":"additional","affiliation":[{"name":"Transplant Infectious Diseases and MGB Transplant Center Massachusetts General Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7979-2458","authenticated-orcid":false,"given":"Seyed M.","family":"Hosseini\u2010Moghaddam","sequence":"additional","affiliation":[{"name":"Ajmera Transplant Centre University Health Network University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3201\/EID1010.030985"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.7759\/CUREUS.27727"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/tid.14321"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.14322"},{"key":"e_1_2_11_6_1","first-page":"359","article-title":"A Multi\u2010Center Analysis of Risk Factors for Pneumocystis Pneumonia (PCP) in Solid Organ Transplant Recipients","volume":"18","author":"Hosseini\u2010Moghaddam S.","year":"2018","journal-title":"American Journal of Transplantation"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399\u20103062.2011.00645.x"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005792\u2010199711000\u201000004"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2015.316"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000003576"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/CTR.15320"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/1465\u20109921\u201014\u201087"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365540601150497"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3182384b57"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.12119"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3182a1618c"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit413"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13587"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.12599"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.14573\/ALTEX.1902131"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/S12874\u2010020\u20100897\u20103"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-201211271-01066"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.4103\/0971\u20104065.132987"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2015.12.017"},{"issue":"12","key":"e_1_2_11_25_1","article-title":"Pneumocystis Pneumonia in Liver Transplant Recipients","volume":"13","author":"Li X. 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